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HOW DOES AN EMPLOYER HANDLE A WORKERS' COMPENSATION CLAIM WHEN AN EMPLOYEE IS INJURED ON THE JOB?
If it is determined that an employee sustained an injury arising out of and in the course of employment, that employee is entitled to workers' compensation benefits. The benefits are paid by either the employer, if the employer is self-insured, or the employer's workers' compensation carrier. However, several questions can arise when an employee is injured on the job.
Does an employer have to provide a workers' compensation claim form to an injured employee if the employee fails to notify the employer of a work related injury?
Yes. Generally, an employee will notify his or her employer of an injury sustained on the job. However, if the employer discovers that an employee sustained a work related injury indirectly or through a third party, the employer must still provide a workers' compensation claim form within 24 hours of knowledge of the injury whether or not the employee has asked for it. The employer shall date the form and provide a dated copy to the employee and a copy must be sent to the employer's insurance carrier. The carrier will handle the matter from that point forward. Within one day after the employee delivers the claim form, the carrier will authorize medical treatment pursuant to specific guidelines while investigating the claim.
Failure to provide a claim form or give the employee written information about the injured worker's rights under the workers' compensation system in a timely manner may result in the employee being able to choose his or her own personal physician for treatment associated with the injury and may extend the statute of limitations or time for filing a claim.
How does an employer decide which doctor to send the injured worker to?
When an employee is hired, the employer must provide a form to the employee indicating that the employee can designate a doctor of his or her choice for medical treatment. If the employee did not designate a physician prior to sustaining a work related injury, the insurance carrier can control the medical treatment for the first 30 days after the injury is reported. The carrier will send the injured worker to a doctor within the carrier's medical provider network (MPN). The MPN is an entity or group of health care providers set up by an insurer or self-insured employer to treat workers injured on the job. The carrier usually gives the employer information on the local doctors to have on hand to refer employees to when an injury occurs. Call your insurance carrier if you do not have this list.
There are various rules that govern the selection process of treating physicians within the workers' compensation network. When in doubt, contact your attorney for guidance.
If an employee does not want to make a workers' compensation claim does the employer have to make the claim for the employee anyway?
No. Upon receiving notice that an employee was injured at work, the employer must provide a claim form to the injured worker. The insurance carrier will provide notice to the employee of the employee's potential entitlement to workers' compensation benefits. However, it is the injured worker's choice as to whether to actually file a workers' compensation claim.
If an employer suspects that an employee is lying about sustaining a work related injury, does the employer still have to provide a workers' compensation claim form to the employee?
Yes. However, the employer can be protected from potential fraud. If an employer suspects that an employee was not truly injured on the job, the employer should gather evidence to support that suspicion. For example, the employer should take employee statements and provide the statements to the insurance carrier. The carrier will then conduct an investigation and take appropriate action.
Obviously the above information is not meant to be an exhaustive list of all the rules an employer must follow when an employee sustains a work related injury. If an employer is self-insured or uninsured, it is always good practice to discuss proper workers' compensation procedure with a workers' compensation attorney. Be advised that there are penalties associated with the failure to have workers' compensation insurance.
Oakland Business ReviewThis article is intended to provide general information only and is not meant to provide legal advice to any specific individual or case. If you are interested in discussing a specific matter, please contact an Ericksen Arbuthnot attorney.